Advertisement
Research Article|Articles in Press

Influenza Vaccinations Among Privately and Publicly Insured Children With Asthma

Published:March 02, 2023DOI:https://doi.org/10.1016/j.acap.2023.02.010

      Abstract

      Objective

      Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors.

      Methods

      This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014–2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics.

      Results

      The sample included 317,596 child-year observations for children with asthma in 2015–18. Fewer than half of children with asthma received influenza vaccinations; 51.3% among privately insured and 45.1% among Medicaid insured. Risk modeling reduced, but did not eliminate, this gap; privately insured children were 3.7 percentage points (pp) more likely to receive an influenza vaccination than Medicaid-insured children (95% confidence interval [CI]: 2.9–4.5pp). Risk modeling also found persistent asthma was associated with more vaccinations (6.7pp higher; 95% CI: 6.2–7.2pp), as was younger age. The regression-adjusted probability of influenza vaccination in a non-office setting was 3.2pp higher in 2018 than 2015 (95% CI: 2.2–4.2pp), and significantly lower for children with Medicaid.

      Conclusions

      Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Centers for Disease Control and Prevention. 2019 National Health Interview Survey Data. U.S. Department of Health & Human Services; 2019. 〈https://www.cdc.gov/asthma/nhis/2019/data.htm〉.

      2. Centers for Disease Control and Prevention. AsthmaStats: Uncontrolled Asthma Among Children, 2012–2014. U.S. Department of Health and Human Services; 2019. 〈https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children.htm〉.

        • Volerman A.
        • Chin M.H.
        • Press V.G.
        Solutions for asthma disparities.
        Pediatrics. 2017; 139e20162546https://doi.org/10.1542/peds.2016-2546
      3. Centers for Disease Control and Prevention. Prevention and Control of Influenza Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR; 1990:1–15. 〈https://www.cdc.gov/mmwr/preview/mmwrhtml/00001644.htm〉.

        • Grohskopf L.A.
        • Alyanak E.
        • Ferdinands J.M.
        • et al.
        Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 Influenza Season.
        MMWR Recomm Rep. 2021; 70: 1-28https://doi.org/10.15585/mmwr.rr7005a1
      4. U.S. Department of Health and Human Services. Increase the Proportion of People who Get the Flu Vaccine Every Year — IID‑09. Healthy People 2030. 〈https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-people-who-get-flu-vaccine-every-year-iid-09〉. Accessed June 1, 2022.

        • Friedman B.C.
        • Goldman R.D.
        Influenza vaccination for children with asthma.
        Can Fam Physician. 2010; 56: 1137-1139
        • Norman D.A.
        • Barnes R.
        • Pavlos R.
        • et al.
        Improving influenza vaccination in children with comorbidities: a systematic review.
        Pediatrics. 2021; 147e20201433https://doi.org/10.1542/peds.2020-1433
        • Murphy E.V.
        Improving influenza vaccination coverage in the pediatric asthma population: the case for combined methodologies.
        Yale J Biol Med. 2014; 87: 439-446
        • Dombkowski K.J.
        • Lamarand K.
        • Dong S.
        • et al.
        Using Medicaid claims to identify children with asthma.
        J Public Health Manag Pract. 2012; 18: 196-203https://doi.org/10.1097/PHH.0b013e31821a3fa7
        • Simon A.E.
        • Ahrens K.A.
        • Akinbami L.J.
        Influenza vaccination among US children with asthma, 2005–2013.
        Acad Pediatr. 2016; 16: 68-74https://doi.org/10.1016/j.acap.2015.10.006
        • Gnanasekaran S.K.
        • Finkelstein J.A.
        • Lozano P.
        • et al.
        Influenza vaccination among children with asthma in Medicaid managed care.
        Ambul Pediatr. 2006; 6: 1-7https://doi.org/10.1016/j.ambp.2005.08.004
      5. NCQA. HEDIS 2017 Final NDC Lists. NCQA. 〈https://www.ncqa.org/hedis/measures/hedis-2017-national-drug-code-ndc-license/hedis-2017-final-ndc-lists/〉. Accessed June 1, 2022.

        • Schwarze J.
        • Openshaw P.
        • Jha A.
        • et al.
        Influenza burden, prevention, and treatment in asthma – a scoping review by the EAACI Influenza in asthma task force.
        Allergy. 2018; 73: 1151-1181https://doi.org/10.1111/all.13333
      6. The Secretary of the Commonwealth, William Francis Galvin, Secretary. The Massachusetts Register.; 2017.

      7. Center for Health Information and Analysis. 2014–2018 Massachusetts All-Payer Claims Database. 〈https://www.chiamass.gov/ma-apcd/〉.

      8. Children Helping Improve Pediatric Practice, Education & Research (CHIPPER). Pediatric Asthma Emergency Department Use, ICD/CPT Codes. 〈https://chipper.ucsf.edu/studies/implement/documents〉.

        • Bardach N.S.
        • Neel C.
        • Kleinman L.C.
        • et al.
        Depression, anxiety, and emergency department use for asthma.
        Pediatrics. 2019; 144e20190856https://doi.org/10.1542/peds.2019-0856
        • Jacob C.
        • Haas J.S.
        • Bechtel B.
        • et al.
        Assessing asthma severity based on claims data: a systematic review.
        Eur J Health Econ. 2017; 18: 227-241https://doi.org/10.1007/s10198-016-0769-2
        • Worsham C.
        • Woo J.
        • Jena A.B.
        Birth month and influenza vaccination in children.
        N Engl J Med. 2020; 383: 184-185https://doi.org/10.1056/NEJMc2005928
      9. Centers for Medicare & Medicaid Services. HCPCS/CPT Codes for Flu Shots. 〈https://www.cms.gov/medicare/preventive-services/flu-shot-coding〉.

        • NCQA
        HEDIS Measures and Technical Resources, HEDIS Measurement Year 2021 Vol 2: Technical Specifications for Health Plans.
        NCQA. 2022; (Accessed June 1) (Accessed June 1) (Accessed June 1)
      10. Centers for Medicare & Medicaid Services. Center for Consumer Information and Insurance Oversight - Regulations and Guidance. 〈https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance〉.

      11. Immunize.org. Influenza Vaccine Mandate for Child Care and Pre-K. 〈https://www.immunize.org/laws/flu_childcare.asp〉. Accessed June 1, 2022.

      12. Health Affairs Blog. Increased Reimbursement May Help Overcome Barriers to Administration of Seasonal and Routine Vaccines. 2020. 〈https://www.healthaffairs.org/do/10.1377/forefront.20201208.111539/full/〉. Accessed May 30, 2022.

        • Tsai Y.
        Payments and utilization of immunization services among children enrolled in fee-for-service Medicaid.
        Med Care. 2018; 56: 54-61https://doi.org/10.1097/MLR.0000000000000844
        • Kempe A.
        • Saville A.W.
        • Albertin C.
        • et al.
        Parental hesitancy about routine childhood and influenza vaccinations: a national survey.
        Pediatrics. 2020; 146e20193852https://doi.org/10.1542/peds.2019-3852
        • Aigbogun N.W.
        • Hawker J.I.
        • Stewart A.
        Interventions to increase influenza vaccination rates in children with high-risk conditions—a systematic review.
        Vaccine. 2015; 33: 759-770https://doi.org/10.1016/j.vaccine.2014.12.013
        • Lee B.Y.
        • Mehrotra A.
        • Burns R.M.
        • et al.
        Alternative vaccination locations: who uses them and can they increase flu vaccination rates.
        Vaccine. 2009; 27: 4252-4256https://doi.org/10.1016/j.vaccine.2009.04.055
        • Mehrotra A.
        • Wang M.C.
        • Lave J.R.
        • et al.
        Retail clinics, primary care physicians, and emergency departments: a comparison of patients’ visits.
        Health Aff (Millwood). 2008; 27: 1272-1282https://doi.org/10.1377/hlthaff.27.5.1272
      13. The Commonwealth of Massachusetts. Board of Registration in Pharmacy Drug Control Program Immunization Program Policy 2020–11: Vaccine Administration; 2021. 〈https://www.mass.gov/doc/2020–11-vaccine-administration-0/download〉.

      14. The Commonwealth of Massachusetts. Statistics About Asthma. 〈https://www.mass.gov/service-details/statistics-about-asthma〉. Accessed June 1, 2022.

      15. Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2020–21 Influenza Season. 2021. 〈https://www.cdc.gov/flu/fluvaxview/coverage-2021estimates.htm〉. Accessed May 30, 2022.